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General NPI Number Information
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NPI Number | 1205798030
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Entity Type | Organization
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Legal Business Name | BROOKLYN DENTAL HOME PC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 3755 82ND ST FL 2
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7031
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Country | US
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Telephone | 718-703-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11229-1426
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Country | US
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Telephone | 718-645-1588
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ARIEL AMINOV
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Credential |
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Telephone | 516-512-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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